Marty, a 22-year-old fresh engineering graduate, visited my clinic together with his mom. He said he had a skin problem for almost five years and had been to several dermatologists, but to his dismay, no particular medicine really worked for him. His skin had severe flaking, mostly on his lower torso, sparing only the extremities (arms and legs), and face. There was no redness, but mild itching was present. He complained that he applied several topical creams and lotions, taken different oral medications but his skin remained the same for the past five years. Since Marty’s skin did not look like contact dermatitis, atopic dermatitis, psoriasis and definitely not xerosis, I took a small piece of skin to find out what really was his problem. It turned out to be a pigmentation problem, which puzzled me even more. In Marty’s case, an excellent medical foundation and training came in handy.
So, finally, the pigmentation problem was caused by a superimposed, almost generalized, seborrheic dermatitis. Medicines were prescribed, which improved the patient’s generalized scaliness a hundred percent, meaning the flaking was all gone. Marty’s mother was repeatedly thankful because, according to her, in those five years that they went to several doctors, she literally lost hope of ever finding a cure for her only son and was worried that his condition would even get worse. So, in this particular case, the skin biopsy was also partially accurate because the patient really had pigmentation on his skin which was clinically camouflaged by the thick scale. But then the biopsy failed to identify the other superimposed condition, which was the seborrhea. The patient was given oral and topical medicines for his problem and in less than a week, the scaling disappeared. So, here is one happy ending to a story.
Seborrheic dermatitis is a common skin problem that mainly affects the scalp. It causes scaly patches, red skin, and stubborn dandruff. But it can also affect oily areas of the body, such as the face, upper chest and back.
Seborrheic dermatitis doesn’t affect your overall health, but it can be uncomfortable and cause embarrassment. It isn’t contagious, and it’s not a sign of poor personal hygiene. It is, however, a long-term condition which means it may return later. You may be able to manage flare-ups by recognizing seborrheic dermatitis symptoms and using a combination of self-care steps and medications.
The exact cause of seborrheic dermatitis is unknown. Doctors think it may be due to a combination of hormone levels, weakened immune system, lack of certain nutrients, or nervous system problems. In addition to sebum, this dermatitis may be linked to an irritation from a yeast called Malassezia (fungal organism). Seborrheic dermatitis appears to run in families. Various medications may also induce seborrheic dermatitis. Its severity ranges from mild dandruff to exfoliative erythroderma (where the skin sheds severely like a snake changing its skin).
Trigger factors include stress or fatigue, weather extremes, spicy foods, caffeine, alcohol, smoking, infrequent shampooing or skin cleaning, using lotions that contain alcohol, neurologic and psychiatric conditions, including Parkinson’s disease, head injury or stroke and depression.
Creams, shampoos or ointments can control inflammation. Prescription-strength anti-inflammatory drugs applied to the scalp or other affected areas are effective and easy to use. But if used for many weeks or months without a break, they can cause side effects such as infections, redness of the skin, atrophy (lumulubog yung balat), the appearance of spider veins, acne. Antifungal shampoo, alternated with a stronger anti-inflammatory medication twice weekly, may also help.
Creams or lotions containing the calcineurin inhibitors may be effective and have fewer side effects than anti-inflammatories. But they are not the first-choice treatments because of a potential increased risk of cancer. In addition, they cost more than mild anti-inflammatory medications.
Light therapy with medication may also be used. Photo chemotherapy may likewise be used in some cases.
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